Trying to Conceive: After Birth Control

What effects, if any, do the pill, Depo-Provera, or other birth control choices have on your fertility? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on May 24, 2004, to talk about TTC after birth control, as well as the first baby steps to parenthood, from understanding your cycle to the ABCs of fertility charting.

The opinions
expressed herein are the guests' alone and have not been reviewed by a WebMD
physician. If you have questions about your health, you should consult your
personal physician. This event is meant for informational purposes
only.

MEMBER QUESTION:Dr. Grunebaum, is it true that if I have been on birth control pills for 16 months, it will take me time to conceive? I have been TTC the past five months and am not pregnant. Thank you.

DR. AMOS:The birth control pill works by preventing ovulation. Once you stop taking the pill, the hormones are out of your body quickly, usually within a couple of days. When the hormones are gone your body needs to start again on its own to function. That mean it will start producing follicles again, which eventually lead you to ovulate. Everybody acts differently, some may take a couple of weeks to ovulate, other may take some months, but in general your body should be in "normal mode" within less than two to three months after stopping the pill. So if you now ovulate normally, that means your body is back to its normal rhythm.

Now, if you had problems with ovulation before you started the pill then the same issues may still be there. Some women take the pill for irregular periods and ovulation, and you cannot expect this to change once you stop the pill.

By the way, five months of TTC is not long enough to be concerned. It takes on average four to five months to get pregnant, and 85% of couples take up to one year. Good luck.

MEMBER QUESTION:Does the same rule apply to 10 plus years of birth control pill?

DR. AMOS:No matter how long you took the pill it's the same if it's six months or 10 years. Your body should get back to ovulating normally quickly.

MEMBER QUESTION:Is it safe to get pregnant after the two to three months, or can there be complications with the health of the baby from taking the pill that long?

DR. AMOS:It's safe to get pregnant the day after you stop the pill. Once you stop the pill the hormones are gone. There are some women who even get pregnant while on the pill, and there are no studies showing that there is an increased risk to the fetus.

MEMBER QUESTION:Is there anything that we can do to ready our bodies after taking birth control?

DR. AMOS:When you TTC the best thing to do is to take a regular preconception supplement. This should usually include 400 micrograms-600 micrograms of folic acid. Taking folic acid significantly decreases your risks of having a baby with birth defects and it also decreases your risk of having a miscarriage.

In order for folic acid to work you must start it at least one to two months prior to conception. When you are on the last pack of the pill you should start taking your preconception supplement.

"It's safe to get pregnant the day after you stop the pill. Once you stop the pill the hormones are gone."

MEMBER QUESTION:My husband and I are eager to start TTC No. 2. I am in my second month off of BCPs (first month was 29 days) and now this month I am on CD 67. Do you think that I should call my doctor now and set up an appointment to maybe get some meds to bring on AF, or do you think that I should wait it out a bit longer?

DR. AMOS:A long cycle without being pregnant is usually due to not ovulating. As mentioned before it can take several months for your body to get back to normal, but it's always a good idea to let your doctor know about not having a menses. This allows you to discuss what to do next and when your doctor wants to see you.

MEMBER QUESTION:What about Depo-Provera? If I take it, after I decide to stop could it take me some time to get pregnant?

DR. AMOS:Depo-Provera is very different from taking the pill. The hormones of the pill are out of your body once you stop taking the pills. Depo-Provera however works by continuously sending hormones into your body. One injection usually works for at least three months and sometimes longer. That's why after the last shot of Depo-Provera it can take up to nine to 12 months for all the hormones to get out of the body. Only when the Depo-Provera stops sending the hormones can your body regain control and start ovulating again on its own. That's why Depo-Provera is not a perfect contraceptive for women who are considering getting pregnant soon.

MEMBER QUESTION:What about IUDs with hormones? If I have one and have it removed, is it possible to get pregnant right away?

DR. AMOS:IUDs with hormones work differently than Depo-Provera. Once the IUD is removed the hormones have left your body.

MEMBER QUESTION:I believe that I am ovulating after being off the pill for two months, because I am charting my BBT. It appears I had ovulated by day 29. I am now on day 36 and expecting my period b/c last month my cycle was 35 days. Should I be concerned that I am ovulating so late?

DR. AMOS:It's normal for ovulation to take some time to become regular again. If you ovulated on CD 29 then you would expect your period to come around 14 days later, and that would be around CD 43.

MEMBER QUESTION:Are you ovulating if you get your period on time for your first period after the pill?

DR. AMOS:Good question. Ovulation cannot be determined solely based on bleeding once. If you have regular 28-day cycles then you can assume that you ovulate, but one single episode of bleeding doesn't necessarily mean you ovulated. That's why it's important to check for ovulation also, using a temperature curve. The curve will give you additional information about if and when ovulation happens.

MODERATOR:Speaking of temperature charting, we have a couple of questions about that:

MEMBER QUESTION:Do you always ovulate the day before first temperature rise?

DR. AMOS:No. Your temperature rises after you ovulate, and this can happen one to two days later.

MEMBER QUESTION:Do all women see a dip in temperatures when implantation occurs? How much of a dip is normal at that time?

DR. AMOS:Most pregnant women have no dip at implantation, and most dips are not implantation. You cannot determine from certain changes in the curve alone whether you are pregnant or not. This includes the 'triphasic chart.' If your temperature is elevated for 16 or more days without AF then this is a good sign of being pregnant.

"If you want to get pregnant again in a year or so then Depo-Provera is not a good choice. The pill and IUDs in addition to condoms or diaphragms are options if you want to get pregnant soon."

MEMBER QUESTION:I would like to know if you have a cyst on your ovaries, will that prevent you from conceiving?

DR. AMOS:As long as you ovulate a cyst does not prevent you from getting pregnant. However, you should find out how big the cyst is and what kind of a cyst it is. Most cysts are small, clear cysts and require no further treatments. However, other cysts are bigger and not clear, such as dermoid cysts, and those usually need to be removed by surgery.

MEMBER QUESTION:Do women ovulate between the 10 th day and 18 th day of their period, counting first day of period as day 1?

DR. AMOS:The only stable time is the time between ovulation and the next period. That time is called the corpus luteum period and it lasts about 14 days. So on a 28-day cycle ovulation happens on CD 14. But on a 35-day cycle it happens on CD 21 (35-14). I hope that helps.

MEMBER QUESTION:After a D&C does it take your body a few cycles to regulate? Is it uncommon for ovulation and luteal phase to fluctuate cycle to cycle?

DR. AMOS:It all depends
on why the D&C was done. If it was a miscarriage then your body needs some months to start ovulating again no matter if there was a D&C or not, but if the D&C was a diagnostic D&C then this should not influence ovulation. It's not the D&C that influences ovulation; rather it's the reason why it was done.

MEMBER QUESTION:Are any forms of birth control better than others in the short term; for example if I have had one child and wish to wait only six to 12 months before trying to have another?

DR. AMOS:As I mentioned before, if you want to get pregnant again in a year or so then Depo-Provera is not a good choice. The pill and IUDs in addition to condoms or diaphragms are options if you want to get pregnant soon.

MEMBER QUESTION:What is secondary infertility?

DR. AMOS:Secondary infertility is when you cannot get pregnant but you were pregnant in the past. Primary infertility is when you were never pregnant before.

MEMBER QUESTION:At what point do you get your husband's sperm tested?

DR. AMOS:I usually suggest testing him as soon as possible, preferably as soon as you start trying to get pregnant. Testing him right away can often save you many months of trying in vain, and because it is the only test assuring the person getting tested has an orgasm, how can anyone refuse?

MEMBER QUESTION:What can be done if an irregularity is found in the sperm analysis?

DR. AMOS:That all depends on what the irregularity is. Not enough sperms? Abnormal sperms? Not enough moving? You need to look at the complete test before you decide on the next steps, and oftentimes the test needs to be repeated if it's not normal.

MODERATOR:We have a few great chat transcripts in our Live Event archive that go into the male side of things in great detail. Just search on sperm or male fertility and they'll pop up in the results.

MEMBER QUESTION:I got off the pill on the 11 th this month, had my period on 14 th , and started testing on the 21 st to see if ovulating. I saw two lines, one a little lighter; same on 22 nd and 23 rd . Today the line is really light. Does that mean I just ovulated?

DR. AMOS:Different ovulation tests work in different ways and you need to read the instructions for your particular product carefully to understand them better. In some tests you need the second line to be darker; others just need a second strong line.

MODERATOR:Time flies when you're talking TTC, and we have to wrap up for today. Thanks for joining us. If Dr. Amos wasn't able to answer your question, try posting in his TTC message board, or join us again next time. You can also find dozens of archived Dr. Amos chats in our Live Events archive, which can be found on our boards and chats page, "Member Central." Those transcripts will answer many, many of the unanswered questions from today.

And now you can learn even more about getting pregnant by joining the WebMD Fertility Center. Sign up for support, expert chart review, and tons of great TTC information. You'll learn everything you need to know about increasing your chances of conceiving. Go to fertility.webmd.com for more info.